There is a critical need to examine and evaluate tobacco prevention and control efforts for medically at-risk children and adolescents. High risk subgroups include, but are not limited to, youth with conditions including cancer, cancer survivorship, asthma, diabetes, cystic fibrosis, and others with elevated cardiovascular risk factors, for whom tobacco use and exposure to environmental tobacco smoke (ETS) can pose damaging health consequences. A number of tobacco control studies in at-risk pediatric populations, particularly in pediatric cancer and asthma, have been recently conducted or are currently underway. However, no forum currently exists to integrate the accumulation of research to date and to provide an exchange of information among researchers conducting tobacco-related studies in pediatric populations. A primary purpose of the proposed working conference is to bring together a panel of experts to promote an interdisciplinary dialogue around current and promising approaches to tobacco control in medically at-risk children and adolescents. We plan to critically evaluate the medical, psychosocial, behavioral, and public health aspects of tobacco control initiatives for youngsters with chronic medical conditions and establish an agenda for future pediatric tobacco control research. This effort will ultimately advance our ability to utilize the clinic setting and intervene with youngsters beyond the primary care setting, i.e. those seen in subspecialty clinics. To achieve our goals, a two day meeting to be convened on October 6-7, 2005 at St. Jude Children's Hospital in Memphis, TN, will be organized around 4 major objectives. These objectives will focus on risk factors that contribute to smoking, tobacco prevention and cessation strategies, strategies to reduce ETS exposure, and selection of primary outcomes for tobacco trials with medically at-risk pediatric populations. Each of the objectives will be addressed by 3 to 5 invited speakers who will comprise a Working Group that will promote discussion of more general issues related to a specific topic. In addition, invited discussants will provide an integrative summary of the field and define future direction and recommendations in the area of pediatric tobacco prevention and control. Working Group manuscripts that correspond to each objective will be published as a supplement to the journal, Pediatrics.